FEDERAL COMMUNCATIONS COMMISION Approved by OMB
(美国联邦通信委员会) (管理和预算局通过)
Washington,D.C.20554 3060-0059
(华盛顿特区 20554是邮编)
STATEMENT REGARDING THE IMPORTATION OF RADIO FREQUENCY DEVICES CAPABLE OF
CAUSING HARMFUL INTERFERENCE
(进口能产生有害辐射的射频仪器的报表)
(Read instructions before completing form, Please type or print clearly in ink.)
(在填表之前先阅读声明,请打印或用钢笔填写清楚)
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Part I(第一部分) ALL Blocks MUST Be Completed(所有空格必须填写完整)
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Date of Entry
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Entry Number
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Port of Entry
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Harmonized Tariff Number
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Quantity of Item(not number of containers)
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登记日期
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编目流水号
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报关港
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协制编号
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货物件数(不是包裹数量)
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Device Model/Type Name or #
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Trade Name
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FCC ID
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Description of Equipment
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商品设备型号
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商标
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美国通信委员会发布的号码(一般在说明书上有)
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商品设备描述
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Manufacturer’s Name and Address
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Consignee’s Name and Address
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Importer’s Name and Address
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制造商的名称和地址
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收货人的姓名和地址
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进口商的姓名和地址(如果进口商和收货人是同一个人,那就填收货人的姓名和地址)
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Printed or Typed Name of Importer or Consignee
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Signature of Importer or Consignee
(进口商或收货人签字)
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Date (Month/Day/Year)
日期(月/日/年)
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进口商或收货人的机打名字
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特别说明:1.登记日期、编目流水号、报关港、协制编号可以不填，由联邦快运服务人员填写。
2.FCC ID 如果有的话在产品说明书上应该能够找到.如果没有在第二部分表格中就要选择第二选项.
Warning: Any person who knowingly makes a false declaration may be fined not more than ＄250,000 or imprisoned not more than 5 years, or both, pursuant to 18 U.S.C.§1001.
(依照美国法典第18章第1001款,任何故意虚假申报的个人都将被处以不超过25万美元的罚款或者不超过5年的监禁,或者2罚并施.)
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Part II—With Regard to the Importation of the Described Radio Frequency Device(s), I DECLARE THAT:
(Place an “X” in only one box)
第二部分—关于进口的射频仪器的描述,我声明如下:
(在与你所邮寄的设备最贴进的一项描述前打 “X”,只允许选一项)
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1. The FCC has issued a grant of equipment authorization for the FCC ID listed above.
美国联邦通信委员会已经发出了该设备的认证同意书并且在上面已经填写了美国联邦委员会发布的编号.
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2.An FCC grant of equipment authorization and an FCC ID are not required, but the equipment complies with FCC technical requirements.
该设备没有美国联邦通信委员会的认证同意书和美国联邦通信委员会发布的编号,但是它符合美国联邦通信委员会的技术标准.
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3.The described equipment is being imported in limited quantities for testing and evaluation for compliance with technical requirement or marketing suitability. The equipment will not be offered for sale or otherwise marketed.(See Instructions)
该设备只进口几件样品,以供检测评估是否符合技术标准和市场要求之用.该设备不会用于出售和其他任何商业目的.(参考说明)
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4. The described equipment is being imported in limited quantities for demonstration at industry trade shows and will not be offered for sale or otherwise marketed.(See Instructions)
该设备只进口几件样品用于工业商贸展览,不会用于出售和其他任何商业目的.(参考说明)
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5. The described equipment is being imported solely for export. It will not be offered for sale or otherwise marketed in the U.S.
该设备只在美国转港过境,不用于出售和其他任何商业目的.
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5(a).The described equipment is a non—U.S. standard cellular phone that can only function outside of the U.S.(See instructions)
该设备是不符合美国标准的便携式手机,只在美国境外才能使用.(参考说明)
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6. The described equipment is being imported for use exclusively by the U.S. Government.
该进口设备只供美国政府使用.
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7.Three or fewer radio receivers, computers , or other unintentional radiators as defined in Part 15 of the FCC Rules ,are being imported for an individual’s personal use and are not intended for sale.
该设备属于美国联邦通信委员会法规第15部分明确定义的音频接受器,电脑或者其他无意辐射体,不超过三件.只用于个人使用.不会用于出售.
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8.The described equipment is being imported for repair and will not be offered for sale or otherwise marketed.
该设备只是为了维修而进口,不会用于出售和其他任何商业用途.
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1. Port of Entry Use Schedule D--- Classification of U.S. Customs Districts and Ports for U.S. Foreign Trade Statistics—a four digit code i.e. New York City, NY 1001.
1.报关港的填写依照表格D—参考美国外贸统计的港口和海关分类区的4位数字代码表. 例如:纽约城就填写NY1001.
2. Harmonized Tariff Number--- Harmonized Tariff Schedule of the United States.
2.协制编号---参考美国协制编号表
3.This quantity must be total number of items, not number of containers.
3.填写的数量必须是所发货物的件数,而不是所用包裹的数目.
